Medicaid enrollment is being significantly impacted due to the expiration of the continuous enrollment condition authorized by the Families First Coronavirus Response Act. Since April, millions of individuals have been disenrolled from the program. Simultaneously, millions of others have either re-enrolled or enrolled in the program for the first time.

State data indicates that approximately 9.5 million individuals have been removed from Medicaid since enrollment peaked last April. This trend suggests that Medicaid should return to its pre-pandemic program size of 71 million individuals after the unwinding.

Churn in enrollment has long been characteristic of Medicaid. Before the pandemic, an estimated 1 million to 1.5 million individuals dropped off Medicaid rolls each month.

Many individuals are being disenrolled within a condensed timeframe during the unwinding process. In some states, the situation has proven to be more severe than anticipated.

The Biden administration initially projected that approximately 15 million individuals would lose coverage throughout the unwinding phase. However, their estimate was conservative compared to current data. According to KFF, disenrollments are expected to surpass 17 million, with procedural issues accounting for 70 percent of these cases.

However, approximately two-thirds of the 48 million Medicaid beneficiaries who have undergone eligibility reviews thus far have successfully had their coverage renewed, while approximately one-third have lost it.

There are, however, significant variations among states. For instance, Oregon has only disenrolled 12 percent of its beneficiaries. 75 percent were successfully renewed, while the remaining cases are still pending. Oklahoma has disenrolled 43 percent of its Medicaid beneficiaries during the unwinding phase, renewing coverage for only 34 percent. Approximately 24 percent of cases are still pending.

States have diverse eligibility criteria, with some implementing policies that make it easier for members to remain enrolled. For instance, in Oregon, children can remain on Medicaid until the age of 6 without needing to reapply, while all other individuals receive up to two years of coverage regardless of income fluctuations.

Industry analysts have expressed ongoing concern about the sharper decline in Medicaid enrollment among children compared to usual trends. This is particularly troubling because children typically qualify for Medicaid at higher household income thresholds than their parents or other adults. According to the latest data from Georgetown University, over 3.9 million children have experienced a loss of Medicaid coverage during the unwinding process.

Utah was the only state to survey those who were disenrolled and found that approximately 30 percent were uninsured. Many others secured employer health coverage or enrolled in subsidized plans through the ACA.

The expiration of the continuous enrollment provision has had a tremendous impact on Medicaid enrollment. It marks the single largest health coverage transition event since the first open enrollment period of the ACA. Due to varying eligibility requirements across the country, some states are being affected more than others. As they navigate the second half of the unwinding period, states must make every effort possible to communicate enrollment status changes to their beneficiaries and ensure that their vulnerable populations do not lose coverage.